Medical Records Release Form
Patients may request a copy of their medical record or ask to send it to someone else.
To safeguard your privacy, complete and sign a protected health information (PHI) release form.
On the form, you can let us know:
- What records you want us to release.
- Where to send your records.
- What format — either electronic or paper — you want your records.
UPMC may charge fees allowable under State law and the Federal Health Insurance Portability and Accountability Act (HIPAA). We do not charge a fee to release medical records to physicians or other health care facilities. There may be a fee to release copies for personal use or to release copies to a third party.
Request Your Records From Your UPMC Physician/APP’s Office
(including UPMC Children's Community Pediatrics, UPMC Hillman Cancer Center, and/or UPMC Rehabilitation Institute practices)
Request your medical records from your UPMC provider’s office.
NOTE: This online form is not applicable for patients of UPMC in Central Pa. (Harrisburg, Carlisle, Hanover, Lititz, and York) patients. Please contact your provider’s office to request your records.
Request Your Records From a UPMC Hospital
To request your records from a UPMC Hospital, click on the hospital where you received services.
Southwest Pa.
Northwest Pa. and Western N.Y.
Central Pa.
North Central Pa.
West Central Pa.
Closed Hospitals